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Drug Treatments for Mental Health Illnesses

Announcement

1 in 5 Americans Will Be Affected by Mental Illness This Year

Summary: Living with a mental illness can seem complicated. A person's normal daily activities may become more difficult, relationships can be affected, and finding treatment can seem challenging.

But 1 in 5 Americans – almost 20 percent – experience a mental illness in any given year, according to data collected from the National Survey on Drug Use and Health (NSDUH) in 2014.  Those illnesses range in type and severity, affecting both men and women and both adults and children, and the NSDUH statistics included depression, anxiety disorders, personality disorders, phobias, attention disorders, bipolar disorders and schizophrenia. That means that 1 in 5 Americans may be seeking treatment – perhaps a combination of therapy, medication, and/or brain stimulation – to manage their illness.

Educate Yourself on Today's Medications and Treatments

Senior Couple Reading Medicines

"These are real people that have very serious problems," said Dr. Peter Delany, the director of the Center for Behavioral Health and Statistics and Quality, in a February, 2014 Newsweek article. "The data should be helping us think through how we want to approach helping them get services that they need."

The National Institute of Mental Health (NIH), a federal agency that funds research grants and creates publications to help Americans manage many aspects of mental illness, also offers guidance  in finding health care providers, treatments and clinical trials. But often, finding a health care provider is only the first step.

"Although psychiatric medications don't cure mental illness, they can often significantly improve symptoms," according to the Mayo Clinic. Those medicines can also help make other treatments, like therapy, more effective.

Understanding the medications prescribed to you is important. Sometimes just one medication is recommended; other times, it is a combination of medicines. Your doctor or psychiatrist needs your help in understanding which medications are or are not working for you, and whether you are experiencing any side effects. Often a person's medications are adjusted over time to maximize their efficiency. Here are some ways to learn more about your medications:

  1. Read the information from your pharmacist or the drug manufacturer. The type is tiny, but it's worth learning about possible drug interactions and side effects.
  2. Go online to the Food and Drug Administration (FDA)'s medication guide, where you can look up the names of medications alphabetically, click on them and read the information associated with that drug.
  3. Look up the drug on the online consumer version of the Merck Manual.
  4. Also, the NIM's overview of mental health medications is helpful. It lists most medications by type, i.e. antidepressants, anti-anxiety medications and so on.

Talk with your doctor

To make sure you and your doctor have the same understanding of how your medications will work, you must be sure he or she knows about all other prescriptions and over-the-counter supplements (vitamins or fish oil, for example) that you take. Also, be sure to remind your doctor of any drug allergies or sensitivities you might have.

What's an off-label prescription?

An off-label prescription for a certain medication simply means that the drug was originally intended for one use but is being be prescribed for other uses as well, or perhaps in a different dosage than the one originally studied. It has become a common practice among many doctors, though there are more cautions involved, especially with new drugs. For an off-label usage to become approved, the drug or dosage must go through its own set of FDA procedures. An online FDA page can help you understand the differences between these usages.

Ask your doctor or pharmacist if a drug is being prescribed for an approved use. If not, ask the doctor or pharmacist why it is believed that this medication will work well for your condition. You can also go to an NIM page online to see approved conditions, dosages and usages.

Don't stop your medication on your own

Doctor Explaining Medicines

Perhaps you feel like your medication has done its job and you don't need it anymore. Maybe you feel that there's a stigma attached to medicines for mental illness. Or perhaps the drug seems like it isn't working at all, and you don't see the point in continuing to take it.

The first thing to do? Talk to your doctor. Don't skip this step.

"Stopping abruptly is especially dangerous," said Dr. Ross J. Baldessarini, professor of psychiatry and neuroscience at Harvard Medical School in an online Psych Central article on discontinuing medications.

Quitting a drug all at once, or "cold turkey," can cause many different reactions, depending on the specific prescription. Mild symptoms might include headaches, the sensation of electric "shocks" or dizziness; severe reactions could include potentially life-threatening seizures.

If you and your doctor agree that a medication is no longer needed, the preferred method is to "step down," withdrawing by gradually lessening the dose of the drug over a period of weeks.

Types of Medications and Treatments

There are many different types and kinds of medications that are prescribed for mental illnesses of one kind or another. It's smart to understand the types of medication and treatments typically used for your condition, and to ask your doctor or pharmacist for more details when you need them.

Anti-depressants

Anti-Depression Medicines

Anti-depressants are primarily used to treat depression, but can also be prescribed to help with anxiety, pain or insomnia. Most of them work to increase or balance the levels of neurotransmitters – serotonin, dopamine and endorphins – in the brain, which affects mood.

Selective serotonin reuptake inhibitors (SSRIs) are some of the most commonly prescribed antidepressants. WebMD explains that reuptake inhibitors keep the levels of neurotransmitters higher in the brain, helping regulate outlook and emotion. Older types of antidepressants include tricyclics, and monoamine oxidase (MAOI) inhibitors, which work differently.

A patient and his or her doctor may have to try several antidepressants to determine which has the best effect, so patience and vigilance is important. The patient needs to pay attention to any side effects and changes in mood and communicate those to the doctor in order to help find the best medication.

"The first antidepressant you try may work fine," says the Mayo Clinic in an explainer about the types of medication commonly prescribed. "But if it doesn't relieve your symptoms, or it causes side effects that bother you, you may need to try another. But don't give up. A number of antidepressants are available, and chances are you'll be able to find one that works well for you."

Remember that stopping or reducing the dosage of your antidepressant medication should only be done with your doctor's help. Stopping too quickly can cause withdrawal symptoms, and may cause your depression to worsen.

Anti-anxiety

Everyone experiences worry and anxiety at times in their lives. But when that anxiety affects a person's daily life, affecting his or her ability to function normally, they may have an anxiety disorder, such as a panic disorder, a social anxiety disorder or a generalized anxiety disorder.

Symptoms of an anxiety disorder can be both mental and physical. Extreme anxiety can cause a racing heartbeat, sweating, pain, trembling and/or abdominal distress, and such symptoms often increase the person's level of worry during an anxiety attack or panic attack.

Therapies, support groups and stress-management techniques can all be helpful in battling anxiety. Medications can also help relieve symptoms; they can be prescribed for a short term, while other therapies take effect, or for a longer period of time on an "as needed" basis.

A detailed index of medications prescribed for anxiety on Drugs.com gives brand name, generic name, drug cautions, side-effect information, drug-interaction information and patient tips.

Stimulants

Students Paying Attention

Stimulant medications are a group of drugs that help a person increase his or her alertness, ability to pay attention, or energy. They are most often used to treat Attention Deficit/Hyperactivity Disorder (ADD/ADHD), but also are prescribed for narcolepsy and some depression.

How do they work? As with antidepressants, stimulants increase the levels of certain chemicals in the brain, primarily dopamine. With ADD/ADHD, this means a person is less easily distracted, more focused and more able to prioritize and finish tasks. With narcolepsy, a condition in which a person is plagued by daytime drowsiness, the medications stimulate a person's nervous system to help increase their wakefulness.

Over time, a patient may develop a tolerance to the stimulant drug they are taking, and must work with his or her doctor to find a substitute. Side effects can include headaches, upset stomach, increases in blood pressure, dizziness or dry mouth, although the Cleveland Clinic notes that these issues may resolve themselves as a person gets used to the medication.

Anti-psychotics

Anti-psychotic medication helps manage the symptoms of such mental conditions as dementia, bipolar disorder and schizophrenia. The drugs in this classification act to control hallucinations, paranoia and delusions by blocking certain receptors in the brain's dopamine pathways.

There are two generations of anti-psychotic medications. The first-generation meds were primarily developed in the 1950s; they were effective at controlling symptoms, but had multiple unpleasant side effects. In the 1990s, the second-generation meds were developed that were called "atypical anti-psychotics."  They became as or more effective than the first-generation drugs, and yet had fewer side effects, many of which tend to go away after a few weeks of taking the medicine. Medicines in the second generation have become vital in the treatment of bipolar disorder and schizophrenia.

As with other medications for mental illnesses, a doctor often works with his or her patient to find the best type and dosage depending on symptoms and side effects.

Mood stabilizers

Many medications fall under the category of "mood stabilizers," and while they are most often used to treat bipolar disorder – they suppress the patient's swings between mania and depression – they also are used to treat depression, impulse control and some mental illness in children.

For decades, the "standard" mood stabilizer prescribed for these patients has been Lithium carbonate, which is a mineral-based drug. Other medications used to moderate bipolar disorder are anti-convulsants, such as carbamazepine or divalproex sodium. Names of medications that patients might talk about with their doctors include Quetiapine, Lamictal, Risperdal, Topamax, Seroquel or Paxil. Special cautions are needed for elderly people and for pregnant women.

It is critical for patients on mood stabilizers to not miss doses or go off the medicine without talking to their doctors first.

Hospital and residential programs

Psychological Consultantion

In some cases, a patient would benefit by inpatient treatment at a hospital or a specialized residential program, where the stress of daily life can be left behind and a focus on wellness can take place. Mental Health America offers this perspective:

"While the majority of people with mental health conditions will likely not need to spend time in a hospital or treatment center, an individual may need to be hospitalized so that they can be closely monitored and accurately diagnosed, have their medications adjusted or stabilized, or be monitored during an acute episode when their mental illness temporarily worsens. Hospitalization may occur because someone decides it is the best decision for themselves, at the insistence of a family member or professional or as a result of an encounter with a first responder (emt/paramedic, police officer, etc.)."

There are detailed lists on the internet that can help with finding a hospital or a residential care program and tell a patient what to expect. And the American Residential Treatment Association (ARTA) gives details on dozens of residential facilities, many of which have expertise in particular mental conditions. Also, such in this listing of programs at Houston Behavioral Healthcare Hospital, a consumer can get a comprehensive idea of the degrees available at a given healthcare site.

Brain stimulation

A relatively new area of mental health treatment is that of deep-brain stimulation. Electrodes are implanted in a patient's brain and then are controlled by a device beneath the skin that tells the electrodes when to produce electrical impulses. Those electrical impulses, in turn, regulate the abnormal impulses that the patient's brain produces.

Some of the conditions for which deep-brain stimulation are used are :

  1. Parkinson's disease
  2. Epilepsy
  3. Tourette syndrome
  4. Dystonia
  5. Obsessive-compulsive disorder
  6. Essential tremor

In addition, the therapy is being studied as possible treatment for major depression, addiction, stroke recovery and dementia. Here is a video of Mayo Clinic neurosurgeon Kendall H. Lee, M.D., Ph.D., describing deep-brain stimulation research. And even more recently, neuroscientists at MIT have been researching whether deep-brain stimulation might help relieve the effects of early-stage Alzheimer's disease and stimulate the brain to recover some lost memories.

Who should consider deep-brain stimulation? The University of Pittsburgh's neurological surgery department answers as follows: "This is a common question with a surprisingly simple answer:  Anyone who would get significant benefit from the treatment and can undergo the operation with minimal risk.  It is not necessary to suffer for years after diagnosis with a movement disorder, trying every known combination of medicine, before DBS can be considered.  DBS is a surgical option that is known to improve quality of life for movement disorder patients, so when one's quality of life is dramatically affected by the disease or by medication side effects, it's time to consider DBS."

How to be a proactive patient

Mental illness can be difficult to manage, considering that it often requires coordination of doctors, therapists and medications. However, there are things you can do to help increase the chances of your success.

Talk with others who've had the same experience

In the age of the internet, this is not difficult to do. Lists of support groups in your area can be found by searching online at such websites as healthfinder.gov, the National Alliance on Mental Illness, or Mental Health America. Adding a description of your particular condition to the search will bring up organizations that specialize in that condition.

There are also online chat rooms and support groups for almost any kind of mental illness, where people are sharing their experiences and learning from each other. Here is one example, an online depression support group listing at Psych Central.

Determine your support circle

Women Talking

In addition to your medical team and any support groups, you should also include appropriate friends and members of your family in your support circle. They are powerful tools too, and can listen and offer insight when you most need someone else's perspective.

Track your progress

Man Filling Out Form

Do you sometimes find yourself on the way to a doctor's appointment or therapy appointment without being sure of the questions you want to ask? Keeping a notebook, a journal or even a Word document in your computer where you can make notes can be particularly helpful. This is the place where you keep track of symptoms, side effects, and how you're feeling on a regular basis. Looking back at it over weeks or months can help both you and your doctor see progress – or the lack of it – and take proper action in terms of medication.

Report medication side effects to the FDA

Female Typing on Computer

If you have a bad experience with a medication, don't hesitate to report that experience to the FDA. Its program for such reporting is called Medwatch: The FDA Safety Information and Adverse Event Reporting Program. By clicking on the red "Report a Problem" button, you will be taken to a page that instructs you how to report an adverse reaction to a medication. By then clicking on the blue "Consumer/Patient"  button, you will be taken to a page that asks questions about the medication and any results you experienced from taking it (such as worsening symptoms, or hospitalization).

Conclusion

Managing a mental illness can be complicated. But with the proper information and conversations with your doctor, medications can help. Understanding dosages, side effects and your doctor's expectations of what a prescription will accomplish are all important.

Resources

American Residential Treatment Association
Anxiety and Depression Center of America
Center for Behavioral Health and Statistics and Quality
Cleveland Clinic
Drugs.com
Epilepsy Society
FDA
healthfinder.gov
Houston Behavioral Healthcare Hospital
Johns Hopkins
Mayo Clinic
Medical Daily
Medicinenet.com
Mental Health America
Merck Manual
National Alliance on Mental Illness
National Institute of Mental Health
National Survey on Drug Use and Health
Nature.com
The Parkinson Foundation
Psych Central
Tourette Association of America
University of California, San Francisco
University of Pittsburgh
WebMD